Depression comorbidity in spinocerebellar ataxia

Abstract

This is a description of the prevalence and profile of depressive symptoms in dominant spinocerebellar ataxia (SCA). Depressive symptoms were assessed in a convenience sample of 526 genetically confirmed and clinically affected patients (117 SCA1, 163 SCA2, 139 SCA3, and 107 SCA6) using the Patient Health Questionnaire (PHQ). In addition, depressive status according to the examiner and the use of antidepressants was recorded. Depression self-assessment was compared with an interview-based psychiatric assessment in a subset of 26 patients. Depression prevalence estimates were 17.1% according to the PHQ algorithm and 15.4% when assessed clinically. The sensitivity of clinical impression compared with PHQ classification was low (0.35), whereas diagnostic accuracy of PHQ compared with psychiatric interview in the subset was high. Antidepressants were used by 17.7% of patients and in >10% of patients without current clinically relevant depressive symptoms. Depression profile in SCA did not differ from a sample of patients with major depressive disorder except for the movement-related item. Neither depression prevalence nor use of antidepressants differed between genetic subtypes, with only sleep disturbance more common in SCA3. In a multivariate analysis, ataxia severity and female sex independently predicted depressive status in SCA. The PHQ algorithmic classification is appropriate for use in SCA but should stimulate further psychiatric evaluation if depression is indicated. Despite a higher risk for depression with more severe disease, the relation of depressive symptoms to SCA neurodegeneration remains to be shown.

Bidirectional Connections between Depression and Ataxia Severity in Spinocerebellar Ataxia Type 3 Patients

“…Surprisingly, the depression scores in female were lower than that in males, since depression was more prevalent in women than men according to the general predisposition [28]. The depression was rather common in European SCA3 female patients [14]. However, in American SCA3 patients, the frequency of depression did not show any significant differences in both genders [13].…”

Voxel‐based meta‐analysis of gray and white matter volume abnormalities in spinocerebellar ataxia type 2

“…Previous resting state functional MRI studies also observed the associations between the lingual gyrus and psychiatric symptoms such as depression, loneliness, and anxiety (Lan et al., 2015; Liu et al., 2015, 2017). Although psychiatric symptoms were not reported in the five included studies, they are common in SCA2 patients (Alves‐Cruzeiro, Mendonca, Pereira, Almeida, & Nobrega, 2016; Fancellu et al., 2013; Schmitz‐Hübsch et al., 2011). Therefore, the lingual gyrus may also play a role in emotional processing.…”

“…Among these, spinocerebellar ataxia type 2 (SCA2), one of the most frequent types, is definitely caused by an CAG repeat expansion in the ATXN2 gene (Pulst et al., 1996). Although the main clinical features of SCA2 are a series of cerebellar signs, including ataxic gait, dysarthria, and dysmetria, which highlight the involvement of cerebellum, some other symptoms such as slow saccades, cognitive impairments, peripheral neuropathy, and depression indicate the abnormalities are beyond the cerebellum (Pulst et al., 1996; Rodríguez‐Labrada et al., 2016; Schmitz‐Hübsch et al., 2011; van Gaalen et al., 2011). The morphological study is essential to detect affected areas of SCA2 while exploring associations between affected areas in the whole brain and clinical manifestations of SCA2 may help us more deeply understand its pathophysiological mechanism, which has remained unknown until now.…”

Depression as the Primary Cause of Insomnia and Excessive Daytime Sleepiness in a Family with Multiple Cases of Spinocerebellar Ataxia

“…Estimated prevalence of depression was 17.1% according to the Patient Health Questionnaire algorithm and 15.4% when assessed clinically. 4 We diagnosed depression using DSM-5 criteria and by measuring the effectiveness of antidepressants.…”